Nursing Teaching on Signs and Symptoms of Atrial Fibrillation

1. Fast heart rate: In atrial fibrillation, the impulse for the contraction of heart is initiated from multiple sites in and around the atria.   The impulses that originate in multiple sites in the atria give rise to a chaotic rhythm and the atria typically quiver than contract. This results in an irregular, abnormal, and very rapid contraction of the atria at a rate more than 300 beats per minute.
2. Palpitations: Abnormally fast heart rate can result in palpitations and pressure in the chest.
3. Chest pain: Compromised blood circulation to the heart muscle can occur, resulting in episodes of chest pain.
4. Diminished function of vital organs: Compromised blood and oxygen supply to the vital organs affect their function gradually. Blood supply could be reduced to all organs, such as, brain, heart, lung, stomach, and kidneys, affecting their function. Reduced volume of oxygenated blood in the circulation will result in low blood pressure and result in hypotensive symptoms of dizziness and lightheadedness. Also, reduced blood supply to the brain can result in increased confusion and frequency of dizzy episodes, thus contributing to falls and accidents. Progressively reduced blood supply to the kidneys can result in deterioration of renal function, diminished urine output, increased fluid and waste retention, and renal failure. Reduced blood supply to the muscles can result in reduced oxygen supply to the muscle, thus leading to muscle pain, fatigue, and reduced endurance to activity.
5. Clot formation: The abnormally rapid quivering of the atria can lead to formation of clots with consequent signs and symptoms of thrombosis and embolism. The symptoms can vary depending on the organ systems involved due to the embolus.
6. Shortness of breath: Reduced oxygenated blood supply to vital organs can also result in weakness, shortness of breath and dyspnea.
7. Swelling of extremities: The ineffective and rapid contractions of the lower chambers of the heart result in reduced emptying of the ventricles and compromised pumping of blood into circulation. Back up of blood in the ventricular chambers can lead to increased blood volume and pressure in the ventricular chambers, resulting in enlargement of the heart, progressive weakening of heart muscle, and heart failure. Patients can present with symptoms of heart failure, such as, fluid retention in the chest leading to difficulty in gas exchange in the lungs, swelling of the extremities with pitting edema, and grossly limited exercise tolerance with exacerbation of episodes of shortness of breath.  Patients also can present with progressively reduced output from the heart and consequently, reduced blood supply to the vital organs.